First Person

BRIAN BALOGH: At the beginning of the show, we heard a little bit about schizophrenia’s history as a diagnosis. To end our show today, we’re going to hear from a person who has firsthand experience with that diagnosis. Her name is Elyn Saks, and she’s a Law Professor at the University of Southern California. In 2007, Saks published an autobiography that chronicled her own struggles with the disease. Peter and I reached her at her office.

ELYN SAKS: So basically, schizophrenia, the analogy I give is to a waking nightmare, with all the bizarre images, impossible things happening, and the utter, utter fear. Only with a nightmare, you sit up in bed, open your eyes, and it goes away. No such luck with a psychotic episode.

So for me, my schizophrenia involves delusions. Fixes and false beliefs without evidence. Like, that I’ve killed hundreds of thousands of people with my thoughts. Hallucinations, like, I remember once I saw a man standing with a raised knife. Disorganized and incoherent thinking and speech.

So I had a breakdown on the roof at the Yale Law School my first year there. And I told my friends, I said, are you having the same experience as I am, of words jumping around the cases? I think someone’s infiltrated my cases. We’ve got a case at joint. I don’t believe in joints. But they to do hold your body together. So words are loosely associated but put together don’t make any sense.

BRIAN BALOGH: Professor Saks, did you have experience in an institution? Were you confined to an institution?

ELYN SAKS: I was. I was hospitalized in England, Oxford, England, in around ’77, ’78 for a month. And then the following year for four months. And then my first year at Yale Law School for five months. And that was ’82, ’83. I haven’t been hospitalized since then, although it’s been suggested on occasion. And in a way, my proudest accomplishment, that I’ve been able to function without being hospitalized again.

PETER ONUF: And how did you accomplish that?

ELYN SAKS: Well, I mean, I’d like to say something, first, about my doctors, which since I’ve been hospitalized all those many years ago I’ve had serious episodes, and might have seemed scary and worrisome. And I really cherish and honor the fact that my doctors were willing to sit with a certain amount of anxiety about my dangerousness to myself and other people, for the sake of respecting my wishes not to be hospitalized. It would have been much easier for them just to kind of the book at me, so to speak.

With my friends and family, you know, I don’t really show my illness, except to like my closest friends and my husband, occasionally. And they’re wonderful. They’re supportive. They’re kind. They usually to say to me– and this works for me, but not other people– Elyn, it looks like you’re having a really hard time. It’s probably your illness acting up. Let’s call your doctor, and maybe you need to get on more medication.

So for me, that kind of supportive response is extremely helpful. I have a bipolar friend I tried that with, and he got furious. How dare you say that? So it’s not one size fits all. But I’ve had excellent treatment. Five day a week psychoanalytic therapy for decades and continuing. Excellence psycopharmacology. Once I accepted the need for it. And then a really wonderfully accommodating workplace. It’s a very intellectually stimulating place.

And for me, using my mind to work on a puzzle, or write an argument, or a counterargument is one of my best defenses against my mental illness.

NARRATOR: Professor Saks, since we are with one real historian, at least, Peter Onuf, I’ve got to ask him, how would somebody who presented with these kinds of symptoms, how would they’ve been treated, Peter, in the 18th century?

PETER ONUF: Well, one solution is sequestration, to use a current term. That’s the legendary mad woman in the attic. Being kept restraint, I mean, restraint is probably the common theme, restraint and isolation, given the fact that nobody understood what was happening. Or they attributed it to demons, or possession of some sort, or later on more humanely, to environmental circumstances.

There weren’t any obvious and easy ways to deal with this. It’s not as if people in olden times, just because they couldn’t diagnose things, that they could deal– they could not deal humanely with these situations.

BRIAN BALOGH: Professor Saks, were you constrained when you were in institutions?

ELYN SAKS: I was restrained. You know, for the first couple of days, 20 hours a day. And then for three weeks, maybe five to 15 hours a day for three weeks. It was incredibly traumatic. I had nightmares about it for years. Just, you know, you feel helpless. You feel confused. You never know what you can do to get out. You don’t know how long you’ll be in.

Actually being restraints for over, say, 10 hours, your limbs really start aching. So it’s very painful, as well. And also, there’s evidence that it can be harmful. So the Hartford Courant did a series about restraint deaths. And at they had a Harvard statistician make some estimates, based on the data. And he estimated that every week, one to three people die in restraints. They aspirate or vomit. They have a heart attack. They strangle.

BRIAN BALOGH: So I gather that restraints are still being used?

ELYN SAKS: They are. There’s kind of a trend to stop using them, but there are places that still use them quite a bit.

BRIAN BALOGH: So you you’ve been very gracious about the psychiatric profession. And in fact, you claim that they’ve helped you tremendously, yet they continue to use these restraints. What do you make of that?

ELYN SAKS: Well, I mean, what I’d like to say about treatment is that I’m very pro psychiatry, but I’m very anti force.

BRIAN BALOGH: I see.

ELYN SAKS: I think force is a terrible thing to do to another human being with a terrible illness. It’s not a stable solution. Once you start administering the force the person who has no incentive not to go back. And what I think we should do is study ways to get people to want treatment, so we don’t have to use force.

BRIAN BALOGH: I want to take you, strangely enough, back to Peter’s century. Because, you talked about friends and, I know in some of the material I’ve read about you, you have a very loving husband. Clearly, medication has helped. Clearly, psychoanalysis has helped. But back in Peter’s day, they had friends, and they had family. Am I wrong about that, Peter? You had friends and family back in your period, right?

PETER ONUF: Yeah, we certainly did. Let’s not romanticize them, though. This is the pre-romantic period. But you’re constantly under surveillance. And it may be the modern invention of surveillance and restraint is a substitute for the thick social relations of the early modern period.

ELYN SAKS: Interesting. Well, they actually say that people with schizophrenia do a lot better in developing countries than they do in industrialized societies. And it may be because families are closer, and there’s more tolerance of difference, and that kind of thing.

BRIAN BALOGH: I’d be curious to know what it felt like when you did reveal to the world that you’re a schizophrenic?

ELYN SAKS: You know, it’s sort of interesting, because one of my friends said that I should do my book under a pseudonym. Did I want to become known as quote, “the schizophrenic with a job?” And I didn’t want to become known that way. But then I thought I couldn’t do anything that could be more helpful to people, potentially, than by actually telling my story. Because, it’s a story, thank God, that has a happy ending. And that may give other people hope and understanding. And that feels good to me.

I’m part of Glenn Close’s board, that has members that study stigma. And they find that people coming to understand the mental illness is a brain disease doesn’t reduce stigma, but people putting a human face on the disorder does. And especially if it’s like your workplace. You know the person in the office next door has a mental illness, but you see that they, pretty much, are just like you, and they want the things you want. And they have the same fears and anxieties.

And so I think coming forward is a good thing. It’s easy for me to say, as a woman with tenure. But other people are pretty established, and could do it. And I think if they can, it’s a good thing to do.

PETER ONUF: Well, you’ve done an amazing thing. Which is to take responsibility for your life, and the way you’re treated, knowing that you’re not fully responsible and you need help. It seems to me there’s a big tension, and it’s very hard for us, in our culture, to resolve that.

Between notions of personal responsibility, which go back to the very idea of consent, a regime that’s based on consent. And on the other hand, taking care of others. That sense of social responsibility.

ELYN SAKS: Right. Yeah, that’s extremely well put. I think that’s exactly right.

BRIAN BALOGH: Well, I want to thank you for joining us today, Professor Saks. This has been so illuminating.

ELYN SAKS: Well, thank you.